=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811780414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OLIVIA MARTIN PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 01/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 WOODBURY AVE STE 8B
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51503-7855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-796-2545
-----------------------------------------------------
Fax | 712-847-6095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 WOODBURY AVE STE 8B
-----------------------------------------------------
City | COUNCIL BLUFFS
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51503-7855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-796-2545
-----------------------------------------------------
Fax | 712-847-6095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 3285
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 132844
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------